USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 66
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obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a buman body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Chap. 114, Sec. 46, G. L., (Tercentenary Edition.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Ilealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from bome wben tbe certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the aetion of chemical (drugs or poisons), thermal, or electrieal agents, and deaths following abortion, but also deatbs from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, astbenia, etc. As principal cause name tbe disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Oceupation .- Precise statement of occupation is very important, so that the relative bealthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation bad been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased bad retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301
+ Dufolhas ostor
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
(City or town making return)
Hopital
Oteresa Baby girl Shoremate
(If deceased is a married, widowed or divorced woman, give also maiden name.)
.St
(If nonresident, give city or town and State)
months
15
days,
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SINGLE
(write the word)
il
MARRIED
WIDOWED
OF DIVORCED
(Month)
(Day)
(Year)
19 THEREBY CERTIFY. 15 19 45 to
.. ,
That I attended deceased from
30
19 45
I last saw her alive on
Ocx
30,
19 45, death is said to
have occurred on the date stated above, at.
Immediate cause of death ..
Menicocele x Spina Bifida
Due to 2,
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Important
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20
Was disease or Injury in any way related to occupation ol deceased ?.
r føjer
If eo, specify
...
Si Portanza
(Signed)
238 mamak 18 th
Date ..
10/30
..
M. D.
1945
21.
Place of Barial. Cremation ox Removal. (Clty or Town)
DATE OF BURIAL
19.4/5~
FUNERAL DIRECTOR. 22 NAME OF Frederick magrath
ADDRESS
64 Moudian She Batac
Received and filed
HOUT 1945
19
(Oficial Designation) (Date of Issue of Permit).
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
30,
1945
Ba If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
.years
If less than 1 day
Hours
Minutes
Winthrop Mass;
(State or country)
Mass.
17 Frances Scherenta ( mocha)
Relation, If aus
Informant ..
(Address)
518 Summer St & Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE th, burial of tryheit permit was issued: Www. D. Childurex (Signature of Agent of Board of Health Gr oilers Thealth Office 10/31/45
100m(h)-1-41-4695
PLACE OF DEATH
County) 1 (City of Town) No ...... 2 FULL NAME. (a) Residence. No ... 518 Suman. (Usual place of abode) 2.fr Length of stay: In hospital or institution. (Before death) (Specify whether) 3 SEX F 4 COLOR OR RACE White (or) WIFE of (Husband's name in full) 6 Age of husband or wife if alive. 7 IF STILLBORN. enter that fact here. 8 AGE .Years Monthe Days 15 Usual 9 Occupation :. Industry 10 or Business : 11 Social Security No. 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER Vladimir Sheremeta 14 BIRTHPLACE OF East Boston FATHER (City) ...... 15 MAIDEN NAME OF MOTHER Frances Mahoney 18 BIRTHPLACE OF PARENTS MOTHER (City) .... East .. Boston If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. (State or country) Mass.
N. B .- WRITE PTATNO
mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF
.
Major findings: Of operations
Date of.
Of autopsy
What test confirmed diagnosis?
Duration Important
15 day
(Address)
Malden
Registered No.
199
§ (If death occurred in a hospital or Institution, St. { give its NAME instead of street and number) PHYSICIAN-IMPORTANT
(Was deceased a U. S. War Veteran?
If so. specify WAR)
years
A TRUE COPY ATTEST (Registrar)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shali forthwith, after the death of a person whom he has attended during his last iliness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest of his knowledge and helief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last iilness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or hy section forty-five of chapter one hundred and fourteen, shali, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has heen engaged, insert in the certificate a recitai to that effect, specifying the war, and shail also certify in such certificate hoth the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shali hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been huried, uutil he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and reinove it from a town, from one cemetery to another, or from one grave or tomh other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the hody is buried. No such permit shall be issued until there shail have heen delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of heaith, or em- ployed by it or by the selectmen for the purpose, shail upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shail make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for auch removal; provided, that such hody shali be returned to the town from which it was removed within thirty-six hours after such removal, uniess a permit in the usual form for the re- moval of such body has heen sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-
mix, that the deceased served in the army, navy or marine corps of the United States in any war in which it has heen engaged, such recitai shali appear upon the permit. The hoard of health, or its agent, upon receipt of such statement and certificate, shali forthwith countersign it and transmit it to the cierk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the piace where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall hury a human hody or the ashes thereof which have heen brought into the commonwealth until he has received a permit so to do from the board of heaith or its agent appointed to issue such permits, or if there is no such hoard, from the cierk of the town where the hody is to he huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fuifiliment of the purpose of these laws caiis for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last iliness from disease unrelated to any form of injury.
(2) Board of Heaith physicians wili certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners wili investigate and certify to ail deaths supposabiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electricai agents, and deaths following abortion, but aiso deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to iliness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
-
301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
{ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
29 Bates Ave. Winthrop, Masss.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
( Before death)
( Specify whether)
yeara
months
days.
In this community
2
yrs. -
mos. - days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF D TH
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
5a If married. widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if aliva years
7 IF STILLBORN, enter that fact here.
AGE
Years
Days
If less than 1 day
Hours
Minutes
Usuel
9 Occupation :
At Home
Industry
10 or Business :
11 Social Security No.
None
Malden
12 BIRTHPLACE (City)
( Siate or country)
Mass
13 NAME OF
FATHER
Unable to obtain
14 BIRTHPLACE OF
FATHER (City)
Unable to obtain
(State or country)
15 MAIDEN NAME
OF MOTHER
Alice Wiley
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
Unable to obtain
17 Alice H Poole Daughter
Informant (Address) 29 Bates Ave, Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard, certificata of death was fled wijf me BEFORE The burlahof transit/parmit was Issued : Was Childress (Slenglate of Agent " Board of Health of other
health Officer
( Thate of Those of Peralt) }
18 DATE OF
DEATH
October
32
1945.
(Year
19 I HEREBY CERTIFY, October 28 2945
That /l aMjended decemed from October 31 045
I last saw h.
en
.allve on
October 3/195, death is said to
have occurred on the date stated above, at 2:30A
.m.
Immediate oause of death .. Cerebral Hemorrhage
Due to
Hypertension
Due to
Other conditions.
none
( Include pregnancy within 3 months of death)
Major AndIngs :
Of operations
none
Data of
Of autopsy
none
What test confirmed diagnosis?
clinical
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased
If so, spacify,
(Signed) Jacobs & abrams Be
(Ad 30 )56- Healey
21
Glenwood
Place of Burial, Crematinn or Removal.
(City or Town)
DATE OF BURIAL
November
3
1945
22 NAME OF
FUNERAL DIRECTOR
Jaward S hunolds
ADDRESS
Winthing mars,
Reoalved and filled.
NOV 2 1945
19
( Regletrar)
1
Duration 2 1/2 days IMPORTANT
2-3 years
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physicians to Insert a reoltal to that effect. PARENTS
-
100m(i)-1-44.13634
No.
Winthrop Community Hospital
To be filed for burial permit with Board of Health or its AgenDO
Sarah A (Foster) Paisley
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
Hosp.
Female White
( Month)
8
67
8
Months
14
(Omclai Designation)
Everest
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of bis last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnisbing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relicf expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a pbysi- cian who is a member of the board of bealth, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If deatb is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within tbe commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for auch removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained bereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person sball bury a human body or the ashes thereof which have been brought into the commonwealth until be has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to sucb deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose pby- sician is absent from home wben the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, astbenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home bousework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation by the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
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